OPHTE# 1`l—f —3yz5(, Harnett County Department of Public Health 23572
PERMIT # NO '5G / Operation Pit
er
E-� New Installatio ptic Tank EE Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner)/', s / > -�_ SUBDIVISION 3o o� �r LOT # `� 3
System Installer: Registration #
Basement with plumbing: ❑ Garage Er. umber of Bedrooms 3
Type of Water Supply: El Community L� Public ❑ Well Distance from well feet
System Type: S Z � ,^ i r�z Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner mulf contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
rtnrnl Lunuuwns:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
IffA �5�
It
`fbl 0
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box ❑
Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications
for the sewa a disposal system on the above captioned property.
Type of system: ❑
Conventional I1Other
5'%- 76-DuC _
Septic Tank: —I�a o gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch Z feet
ditches feet ditches 2 g %1 g inches
French Drain Required: Linear feet
Authorized State Ag�nt�� Date
�i'
alt y
q�r
e x
a n
14-5-34256 (11)
14-5-34256 (12)
14-5-34256 (13)
14-5-34256 (14)
14-5-34256 (15)
w
q
14-5-34256 (16)
14-5-34256 (17)
14-5-34256 (18)
14-5-34256 (19)